[Remote] Clinical Consulting Manager
Note: The job is a remote job and is open to candidates in USA. Netsmart is a healthcare software company dedicated to improving care delivery in behavioral health, human services, and post-acute markets. They are seeking a Clinical Consulting Manager to support clinical excellence and quality outcomes in home health and hospice care, providing guidance and operational support to enhance patient care delivery.
Responsibilities
- Perform documentation review on medical records to identify clinical elements for accuracy
- Perform post-acute home health and or hospice documentation review on medical records to identify clinical elements for accuracy
- Research and provide comments and recommendations on complex or newly issues home health and or hospice billing regulations
- Review client information systems for complete and accurate clinical documentation
- Research and provide comments and recommendations on complex or newly issued billing regulations
- Conduct weekly calls with the client to present findings and results of the engagement
- Analyze trends and provide process improvement recommendations for clinical operational processes to improve quality of care and patient outcomes
- Review documentation associated with focused medical reviews and write appeals for denied services; provide denial support at the Administrative Law Judge (ALJ) level of appeals
- Participate in cross-team clinical consulting work
Skills
- Associate's Degree in nursing, social work, physical therapy or another related discipline
- Active and unrestricted license in related field
- At least 5 years of progressive post acute clinical management experience in home health and /or hospice
- Experience with case management in home health and/or hospice with progressive involvement in Quality Assurance activities
- In-depth knowledge of condition of participations and conditions of payment; extensive knowledge of regulatory standardized assessment documents and patient care protocols
- Proficient in Microsoft Office Suite including Excel, PowerPoint, and Word
- Excellent written and verbal communication and presentation skills are required
- Bachelor of Science in nursing (BSN), social work (MSW), physical therapy or another related discipline
- Experience with Medicare contractor audits and appeals
Benefits
- Comfortable with remote work arrangements and virtual collaboration tools
- Travel up to 25% as needed
- Pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense
Company Overview